The anorectal fistulous abscess and fistula

Conclusion Etiology, pathology and surgical management, herein discussed, are based on information gained from a study of the records of over 500 patients, nearly all of whom were private, and in whom a careful follow-up study was available. The modern approach herein outlined reverses the deeply ingrained teaching of the management of large wounds with wide skin and tissue sacrifice required to assure the wound will heal from within outward. Maximum conservatism in the sacrifice of skin is stressed throughout the presentation. Cure is accomplished by the linear or curvilinear incision utilized to provide exposure. In the cryptoglandular intermuscular group of fistulous abscesses, most of the surgical procedure is performed within the anorectum and healing proceeds from without inward. Deep infections of the ischiorectal fossae are managed effectively by a conservative plastic procedure. Thirty per cent of the total cases were selected for ambulatory surgery, the operations being performed with the patients under the influence of local infiltration anesthesia.